Development of Clinical Pharmacy Services in China


by Jonathan Penm

Jonathan Penm is the Vice President (Western Pacific) of the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP) and the Chair of the New South Wales Branch of the Society of Hospital Pharmacists of Australia (SHPA). He works as a clinical pharmacist at Sydney Hospital and Sydney Eye Hospital and is also completing his PhD at the Faculty of Pharmacy, University of Sydney. Jonathan’s thesis centres on hospital pharmacists' influence on prescribing in the Western Pacific Region, which consists of 37 nations. His enthusiasm for hospital pharmacy has also been recognized as he has been awarded the FIP Young Pharmacist Grant for Professional Innovation in 2010 and the Young Alumni Award for Achievement from the Faculty of Pharmacy, University of Sydney in 2012.

quote It is estimated that 90% of public hospitals’ revenue is currently generated directly from patients for medications and tests.3,4

Recently, China initiated an ambitious healthcare reform aiming to provide affordable and equitable basic health care to all by 2020.1 This reform focuses on public hospitals, which deliver more than 90% of China’s inpatient and outpatient services.2 The public hospital sector has received limited government funds since the economic reform in 1985. It is estimated that 90% of public hospitals’ revenue is currently generated directly from patients for medications and tests.3,4 Furthermore, medications alone account for over 50% of this revenue.1,5 This has led to a perception of inappropriate prescribing. Reynolds and McKee (2009) claimed two forms of financial incentives to prescribe existed in China; ‘One was created by pharmaceutical companies, who sometimes arrange to split profits with prescribers, illegally and covertly, while the other emanated from all health providers, which are entitled to make a 15% profit on sales to fund services.’6 As a result, over-prescribing has become a concern in the context of China’s increasing healthcare expenditure.1


To meet the goals of the healthcare reform, and change the way health is delivered and paid for in China, new policies issued by China’s Ministry of Health (MoH) surrounding the accreditation of tertiary hospitals7 and antimicrobial use in hospitals8 mandate clinical pharmacy services be integrated into China’s hospitals. Internationally, the development of clinical pharmacy services has expanded the role of a pharmacist from the traditional product-focused role to a patient-focused one.9,10 This new role aims to provide patient-focused care and promote high quality and rational use of medications.


China’s MoH conducted a pilot program to introduce clinical pharmacists in 50 hospitals from 2005-2008.11 At the conclusion of this pilot, nearly all directors’ of hospitals, doctors, patients and pharmacy directors surveyed (n=207) supported the role of clinical pharmacists.12 As a result, in 2011 the MoH issued a policy that all secondary and tertiary hospitals should have three and five full-time clinical pharmacists respectively.13


Antimicrobial stewardship has provided a platform for facilitating clinical pharmacy services in China, as antimicrobial resistance is of major concern.14,15 From 1999-2001, the prevalence of resistance amongst hospital-acquired staphylococcus aureus infections was 77%,14 and streptococcus pneumonia over 80%15 and is on the rise.8 Accordingly, the MoH released a series of campaigns and policies8,16 stating that all secondary and tertiary hospitals should have clinical pharmacists trained in infectious diseases. Furthermore, these trained pharmacists must be able to give guidance and approval for restricted antimicrobial use.8 This highlights the important contribution clinical pharmacy services have on antimicrobial stewardship as per international practices.17


Research led by the University of Sydney has highlighted the importance of policies and administrative support, which appear crucial for the successful implementation of clinical pharmacy services, particularly to off-set the financial incentives gained from inappropriate prescribing.18 The Basel Statements (2008), developed by the International Pharmaceutical Federation (FIP) Hospital Pharmacy Section, are consensus statements reflecting the profession’s preferred vision for hospital pharmacy practice around the world. These statements support both developed and developing countries in strategically framing clinical pharmacy services in hospitals.9-21


quote China is well on the way to changing the health landscape, and it is recognised that pharmacists plan an integral role. We did, however, identify that many barriers to change exist, such as the financial incentives prescribers receive, education, training and evaluation of the clinical pharmacists.18

We utilised these statements to develop an interview guide and interviewed over 100 pharmacists and hospital administrators about their practice. China is well on the way to changing the health landscape, and it is recognised that pharmacists plan an integral role. We did, however, identify that many barriers to change exist, such as the financial incentives prescribers receive, education, training and evaluation of the clinical pharmacists.18 Furthermore, ensuring clinical pharmacists are adequately trained is a challenge in China, and will require more time. By the end of 2011, China was reported to have 1399 tertiary and 6468 secondary hospitals,22 which will require at least 26,399 clinical pharmacists to meet the policy requirements of the MoH.13 With only 15 clinical pharmacists graduating from one of the country’s largest courses in 20074,5 and new courses only introduced recently, a focus on educating pharmacists and pharmacy support staff seems vital. It therefore seems inevitable that there will be a large lag time before these MoH goals are reached and clinical pharmacy services are a routine part of hospital systems.


We strongly recommend that the Basel Statements continue to be used to assess clinical pharmacy services in China as they are internationally recognised, regardless of the level of clinical pharmacy services provided or the country in which they are being implemented.


Clinical pharmacists in China have expressed a great need to assess their contribution to the hospital. Having such a system will ensure all departments in the hospital have the same expectations and will allow individual pharmacists to focus their efforts on the essential elements of clinical pharmacy services.


Development of Clinical Pharmacy Services in China

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